New Patients

Medical History and Consent Form

Our team was carefully handpicked by Dr Bonny to provide a clinic of medical professionals only. We pride ourselves in using the highest quality products alongside our skill and knowledge of anatomy, physiology and aesthetics to deliver results. With a range of professional medics in our team, from doctors, nurses, pharmacists and dentists- your face, body and skin are in the best hands.

Medical History

Have you suffered from or had any of the following conditions?



See the available treatments in the photo at the top of this page. Please ask your practitioner if you would like to discuss a treatment which isn’t mentioned above.

I hereby consent to the following:

I have no known allergy to local anaesthetic cream or injections and understand that either or both may be required as part of my treatment.

In having treatments from the treatment provider, I consent to have my aesthetic records maintained for 10 years which is a requirement from insurance companies for all providers of aesthetic procedures.
Any details stored will be done so securely and not used for marketing purposes or any other purpose without prior consent.
This information is maintained under article 9(2) of the GDPR for these reasons:

  • the establishment, exercise or defence of legal claims as necessary.
  • the processing is necessary for public health purposes in the public interest (e.g. protecting against serious cross-border threats to health, or ensuring high standards of quality and safety of health care and of medicinal products or medical devices)

Consent to send Automated Treatment Reminders and to stay in touch

By submitting this form you are consenting to store your data privately on our system. Your private data will be held in accordance with data protection regulations.

Book an Appointment

Select a Location

Belfast Clinic
49 Lockview road, Stranmillis, Belfast

Dublin Clinic
27 Ranelagh Rd, Ranelagh, Dublin

Dundalk Clinic
23 Seatown, Townparks, Dundalk